Social Security Disability News

January 2011

Disparity Between State Agency and Administrative Law Judge Allowance

The Social Security Administration Inspector General recently studied the higher claim payment rate at the hearing level, compared to the State Disability Determination Service (DDS). For the top four impairments leading to denials by State Disability Determination Service, the ALJ allowance rates are telling:

Disorders of the back:

  • DDS denial rate – 78%
  • ALJ allowance rate – 70%

Osteoarthrosis and allied disorders:

  • DDS denial rate – 58%
  • ALJ allowance rate – 70%

Diabetes Mellitus:

  • DDS denial rate – 81%
  • ALJ allowance rate – 67%

Disorders of Muscle, Ligament and Fascia:

  • DDS denial rate – 81%
  • ALJ allowance rate – 65%

Beyond the four discrepant award rates listed above, The Office of the Inspector General also found 27 impairments with a payment rate of at least 80% at the hearing level, including multiple sclerosis and many cancers.

Six states have State Disability Determination Service denial rates above the national average while their hearing offices have above-average allowance rates: Alabama, Georgia, Illinois, North Carolina, South Carolina and Tennessee.

Also, some hearing offices can give significantly different results than other nearby offices: One Chicago hearing office had a back disorder allowance rate of 83%, while a neighboring Chicago office allowed only 45% of these claims.

At the hearing level, the emphasis on residual functional capacity was shown to make a large difference at sequential steps four and five: ability to resume past relevant work or adapt to alternate jobs.

The impact of representation at the hearing level was also clear. The Office of Disability Adjudication and Review noted that several factors “may” be involved: (1) assisting claimants in developing the medical record; (2) selective acceptance of cases; (3) developing additional conditions with work impact, especially mental impairments; and (4) helping claimants to make an effective presentation at the hearing.

ODAR Commissioner Spoke to Attorneys at Their Conference

Glenn Sklar, the Deputy Commissioner for the Office of Disability Adjudication and Review (ODAR), spoke during September 2010 at the Chicago conference of the National Organization of Social Security Claimants’ Representatives (NOSSCR) in Chicago.

Listings Extended

The Social Security Administration has announced that it is extending the expiration of several medical Listings for body systems.

Extended until July 2, 2012:

  • Growth Impairment (Listing 100.00).
  • Respiratory System (Listings 3.00 and 103.00).
  • Hematological Disorders (Listings 7.00 and 107.00).
  • Endocrine System (Listings 9.00 and 109.00).
  • Neurological (Listings 11.00 and 111.00).
  • Mental Disorders (Listings 12.00 and 112.00).

Extended until February 18, 2013:

  • Musculoskeletal System (Listings 1.00 and 101.00)
  • Cardiovascular System (Listings 4.00 and 104.00).

“Wholly” Becomes “Fully”

The Social Security Administration has unified its jargon for describing determinations and decisions. “Fully” has replaced “wholly” in all former references to “wholly favorable” and “wholly or partially favorable.”

Retroactive Medicare Part B

When a favorable disability decision is processed and the Medicare waiting period is already complete, the Social Security Administration begins billing for Medicare Part B prospectively, but offers the option to pay earlier SMIB premiums if there were covered services exceeding the premium cost. Unfortunately, the retroactive SMIB option is all or nothing: A beneficiary cannot choose a coverage start date between the end of the waiting period and the claim effectuation date.

SSI Reinstatement and Continuing Disability Reviews

Where SSI benefits are suspended for non-disability reasons, a claimant can request reinstatement under the same application even if the suspension exceeds 12 continuous months – assuming the non-disability issue has been resolved. However, the reinstatement request will trigger an immediate Continuing Disability Review if there is a past-due review diary date on the record.

Retroactive Period of Disability Freeze

If a period of disability has ended, a retroactive earnings record freeze may be recognized only where a claim has been filed not later than the earlier of: (1) 36 months after disability ceases; or (2) 12 months after attainment of full retirement age.

Age 62: “Throughout the Month” and Age Attainment

Early retirement and spousal claims have no retroactivity. To avoid a benefit loss, Social Security will accept a claim filed up to three months before an applicant reaches age 62. For these claims filed at age 62, benefits begin with the first month in which the applicant is at least 62 “throughout the month.” So a person born on June 15, 1948, attains age 62 during June 2010, and benefits begin with July 2010 (assuming a claim date no later than that month).

However, under the somewhat strange age attainment rules used by Social Security, an individual born on the first or second day of the month will satisfy the “throughout the month” test, allowing an immediate benefit start with the month of the 62nd birthday.

Life Expectancy Calculator

The SSA Chief Actuary has posted a life expectancy calculator to assist in retirement planning: ssa.gov/planners/lifeexpectancy.htm..